PRECISE-DAPT score

PRECISE-DAPT score is a simple 5 item score using age, creatinine clearance, haemoglobin, white-blood-cell count, and previous spontaneous bleeding. It is used to predict out of hospital bleeding with dual antiplatelet therapy. Those with high PRECISE-DAPT score of 25 or more may benefit from a shortened course of dual antiplatelet therapy (DAPT), i.e, less than 12 months. Patients without a high bleeding risk score (below 5) may be given standard duration of DAPT (1 year) or more, without significant bleeding. PRECISE-DAPT was a collaborative study which included about 15 thousand patients [1].

Age cut off taken was 50 – 90 years, hemoglobin 10 – 12 g/dL, upper cut off of creatinine clearance was 100 mL/min, white blood cell count range was between 5 – 20 thousand per microliter. This means values beyond the cut off range were truncated at the cut off level, for the risk calculation. A bedside nomogram was used to calculate risk points for each item and the total points added. Total score ranges from 0 to 100 points. Prior bleeding gives 26 points on the nomogram while creatinine clearance of 0 has 25 points. Hemoglobin 10 g/dL and white blood cell count of 20,000 gives a score of 15 points each, while age of 90 or above gives a score of 19. All these together make a total score of 100 as the highest score possible.

Unlike the DAPT score which is calculated after 12 months of uneventful dual antiplatelet therapy to decide on extended therapy, PRECISE-DAPT score can be calculated at the time of coronary stenting.

A web based risk calculator is available at: http://www.precisedaptscore.com/predapt/webcalculator.html, where you can input the values and get the score calculated automatically. In addition to giving risk score, it gives graphical representation of ischemia and bleeding with short (3-6 months) and long (12-24 months) durations of treatement, risk cluster (low or high), 12 months risk of TIMI major or minor bleeding and 12 months risk of TIMTI major bleeding. There is provision for emailing the pdf report as well.

Reference

  1. Costa F et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017 Mar 11;389(10073):1025-1034.

 

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